DOCTORS SAY ELECTRIC PULSES AIDED BRAIN-DAMAGED MAN

A team of neuroscientists reported Sunday that they had restored some movement and speech to a severely brain-damaged man by stimulating his brain with pulses of electric current.

The 38-year-old man, who had been barely conscious for six years, gradually regained the use of his left arm and began to utter coherent words for the first time since his injury in an assault, the doctors said.

Before surgery to implant two wire electrodes deep in his brain, he could respond to questions and commands occasionally, by moving his thumb or nodding, but was otherwise virtually mute and unable to move.

Experts said the case, presented at the annual meeting of the Society for Neuroscience in Atlanta, could revive interest in electrical stimulation for the estimated 100,000 to 200,000 Americans subsisting in states of partial consciousness.

But they added that it was far from clear how many would benefit, and that there were knotty ethical questions about operating on patients who could not give their consent.

Doctors have long used the implant surgery, known as deep brain stimulation, to treat the rigidity and tremors of Parkinson's disease. They have also tried it on some brain-damaged people in the past two decades, including Terri Schiavo, the Florida woman who died last year after her feeding tube was removed during a national debate over her care.

But in those patients, the treatment was usually performed too soon after the injury to rule out spontaneous improvements, and in most cases, including Schiavo's, it made no difference at all. The new case provides the first convincing evidence that the surgery can be helpful for some patients.

"I think this case suggests that this surgery probably will be one of the choices of treatment we can give to certain patients who have some chance of recovery," said Dr. James L. Bernat, a professor of neurology at Dartmouth Medical School, who was not involved in the case.

Bernat said he did not expect the treatment to help brain-damaged patients who had been totally unresponsive for more than a year. But for those who become occasionally or partly responsive after an injury, he said, "I think we should be aggressive and do whatever it takes" to induce improvement.

The research team, from NewYork-Presbyterian/Weill Cornell, the JFK Johnson Rehabilitation Institute in Edison, N.J., and the Cleveland Clinic Foundation, chose the patient as a test case for several reasons.

He was partly conscious. His condition had been stable for years. And imaging tests showed that widely distributed language circuits running through his prefrontal cortex -- the thinking, purposeful region of the brain -- were intact.

The doctors threaded two wires through the man's skull and down into a subcortical area called the thalamus, which acts as a switching center for circuits that support arousal, attention and emotion, among other functions. The wires were connected to a unit similar to a pacemaker implanted under the man's collarbone.